2.  3 year old boy is brought into ED  T:98.9F P:90 R:19 BP:90/64
by parents after being sent by O2:99%
pediatrician for new onset lower
extremity weakness. Per the
parents, the child is normally  Gen: well appearing, NAD
active, but woke up this morning  HENT: no contusion;ecchymosis
and was unable to get out of bed  Chest/Resp:nml
of his own accord. With further
questioning, mom relates that  MSK:no obvious abnormalities
he fell out of his high chair 2  Neuro: 2/5 MS in bil LE with
days ago but has been behaving decreased sensation to fine
normally since this time. He has touch
no history of seizures and mom
denies that he struck his head  Of note, child is unable to void
during the incident.

4.  Standard cervical spine
films demonstrate no
appreciable abnormality.
CT scan of entire c/t/l
spine and head=nml.
 Family receives dx of
SCIWORA and child
admitted to nsgy for MRI
and further work up

5.  ABC’s / standard work up including probable
ct scans to r/o obvious osseous abnormalities.
 Studies have shown that high dose
methylprednisolone if administered within 8
hours of injury is beneficial—but pro’s and
con’s must be weighed (i.e.
immunosuppression, etc.)
 Will ultimately need an MRI and inpatient
evaluation by neurosurgery.

6.  Occurs most often in pediatric population <8yo
 Thought to be due to elasticity of pediatric cervical
spine.
 Is diagnosis of exclusion and will likely need MRI to
evaluate for cord edema vs. ligamental injury
 May have up to a 4 day delay in presentation
 Needs an obs admission and nsgy consult.
 Keep neck immobilized.

7.  http://www.wheelessonline.com/ortho/sciwora_syndr
ome_spinal_cord_injury_wo_radiologic_abnormality
 Hauda, W.E. Tintinalli’s Emergency Medicine: A
Comprehensive study Guide. Chapter 252: Pediatric
Trauma.
 Veena, K., et al. SCIWORA-Spinal Cord Injury
Without Radiological Abnormality. Indian J Pediatr
2006; 73 (9) : 829-831